Rebecca Smith-Bindman is an Associate Professor of Radiology, Epidemiology and Biostatistics, Obstetrics, Gynecology and Reproductive Medicine at the University of California, San Francisco (UCSF) and director of the Universities' Radiology Outcomes Research Lab. Her research focuses on evaluating the clinical impact of commonly used screening and diagnostic tests. She is applying for a Mid Career Investigator Award in Patient Oriented Research to evaluate the risk of cancer associated with incidental findings identified on ultrasound imaging, and to increase the time she devotes to teaching and mentoring radiology residents and fellows in patient oriented research through creation of a research program for these trainees. If funded, Dr. Smith-Bindman will complete the proposed research, develop a program to encourage radiology trainees to embark on careers in clinical cancer prevention research including one-on-one mentoring of 6-8 trainees annually. This award provides an ideal opportunity to advance her own research agenda and advance her career by developing a program to mentor junior investigators. Over the last 10 years, advances in imaging technology and dramatic increases in the use of imaging have allowed the detection of increasingly smaller and questionable anatomic lesions. The positive impact on patient health from the earlier diagnosis of cancer cannot be overstated. However, one consequence of the increased imaging utilization and resolution is the diagnosis of increasing numbers of incidental and indeterminate findings. Although the pathology risks associated with theses findings is considered very low (the are almost entirely false positive diagnoses), uncertainty regarding their importance and clinical significance, and lack of management guidelines, often generated extensive further testing and surveillance to exclude occult malignancy. The aims of the proposed study are to determine: 1) the frequency that different indications lead to ultrasound imaging of the neck, breast and pelvis 2) the prevalence of incidental/indeterminate findings associated with these examinations and the risk of cancer associated with these incidental/indeterminate findings and 3) to assess surveillance patterns of these lesions. To complete these aims, Dr. Smith-Bindman will conduct a retrospective cohort study of patients enrolled between 1997-2004 in Group Health, a large Not-for-Profit health maintenance organization in Seattle Washington. Group Health has over 500,000 members who obtained over 200,000 ultrasound imaging tests over the years of the study. We will link Group Health's detailed automated clinical data, including indication and result of all radiology testing, with regional Surveillance Epidemiology and End Results tumor registry to determine cancer incidence among all enrollees and associated with the imaging findings. We will use the results of these analyses to develop evidence-based practice guidelines for the management of incidental findings identified on ultrasound imaging.